Bringing People Back From The Brink Of Suicide

This is TALK OF THE NATION. I'm Neal Conan in Columbus, Ohio. Every 15 minutes, someone in this country commits suicide. For each who succeeds, 11 others attempt to kill themselves, and of course many, many more think about it. Friends, family, mental health professionals and others play a part in trying to prevent situations from reaching a crisis, but once one develops, there are also people on the front line of suicide prevention, counselors and volunteers who answer hotlines, law enforcement specialists who reach out to people on the ledge, military officers who train soldiers how to spot suicidal behaviors.

If that's you, call and tell us your story. What works? Our phone number, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. Later in the program, no woman can have it all. Debora Spar, the president of Barnard College, argues the only solution for the women's problem is to recognize the quest for perfection is a myth.

But first, stopping suicide. And we begin with Randall Raybon, a licensed professional counselor and clinical supervisor of Access Helpline with the D.C. Department of Mental Health. They're also part of a network of call centers all over the country that make up the National Suicide Prevention Lifeline. And he joins us today in Studio 3A. Nice to have you on TALK OF THE NATION.

RANDALL RAYBON: Thank you, Neal.

CONAN: And I wonder, I know you've answered calls for 10 years, is there one that sticks out, the one you will always remember?

RAYBON: Probably the most dramatic one we had, 2 a.m. one morning my colleague got a call from someone with a cell phone in Arkansas. And why they called our number I don't know because it was a local number at that time. He was sitting on the tracks. He knew when the next train was coming. It was I think at 2:47. He called us, and he didn't want to live. He wanted someone to talk to.

He wouldn't give us much information. So while my colleague was pulling details from him, I was frantically calling the Arkansas state troopers to try to locate the nearest help to him, and we did get a cruiser to go out and got to him about three minutes before the train was set to arrive.

CONAN: That's, as you suggest, pretty dramatic. Do you tend to remember successes like that, or do you carry the failures with you?

RAYBON: I tend to remember the successes. I try not to dwell on the failures. And thankfully I've never had someone that I directly spoke with commit suicide, or at least I haven't been informed of that.

I understand you decided to get into this line of work in part because of a tragedy in your own family.

Yeah, well, I had always wanted to do something in psychology, and I was in a counseling psychology program, doctoral program in Texas and trying to decide what I wanted to, had just been advanced to candidacy, and a cousin of mine committed suicide. You know, it was a shock because he had everything going for him.

You know, he was - he came from a well-to-do family, a loving family, had a nice girlfriend. He had dropped out of college, but he was back in college and seemed to be doing well. But he was in counseling and on meds, but he still decided to take his own life.

CONAN: And afterwards, everybody wants to know why. And I can still hear that question in the way you describe it.

RAYBON: Thankfully, it was actually one of the more thoughtful suicides, if you can use that term. He wrote a very detailed note. He was very good about having good last contacts at Thanksgiving with family and friends. He shot himself in the bathtub so that he wouldn't cause a mess for people to clean up. And the note explained that at age 22, he was realizing that he was not going to have the life that he grew up in.

He was not going to have the memberships to exclusive country clubs or the nice cars that his dad had, or he didn't think it was going to happen, and if he couldn't have that life, better not to live at all.

CONAN: Wow, that's - yeah. As - when you answer a call, what do you say first?

RAYBON: Well, Suicide Lifeline, this is Randy. How can I help you?

CONAN: And what kind of information - you listen, I assume.

RAYBON: Yes, I listen. My job is definitely much more to listen than to speak.

CONAN: Are there kinds of details that you're trying to draw out?

RAYBON: I'm trying to draw out what the hurt is, you know, what pain is there because most people who are suicidal, they do it because they're in some sort of psychic distress. And so what's the pain, how can we make it better?

CONAN: Do you try to find a location?

RAYBON: Always try to find a location, always try to get contact information, always try to assess if there's a specific plan that they're thinking about, and do they have means to complete the suicide.

CONAN: Where are they on the spectrum of being prepared to actually carry out their suicidal thoughts?

RAYBON: Most people just have a general thought that they don't want to live, that they want the pain to stop, don't want to live. Not every caller has a specific plan. Some do. Some call with very specific plans, and the more specific the plan, the more I worry about them.

CONAN: And every situation, I understand, is different, but there must be themes running through this: stop the pain.

RAYBON: Well, stop the pain, social isolation. You know, people are lonely. They're hurting, you know, they want to reach out. And, you know, I always am pleased when they do reach out. I've been trying to think about what calls are the worst for me. The calls that are worst for me are the ones that I don't get.

The people that are calling, at least part of them wants to live, and I want to hear about that part.

CONAN: We're talking with Randy Raybon, clinical supervisor of the Access Helpline with the D.C. Department of Mental Health. We want to hear from those of you who are also on the end of the phone when people call hotlines to talk about plans to commit suicide. We want to hear from those of you who are reaching out to those on the ledge, 800-989-8255. Email us, talk@npr.org.

And let's see if we can get a caller in, and we'll start with Don(ph), and Don's with us from Pensacola.

DON: Yes, thank you very much. I used to be a volunteer counselor in a crisis hotline, and one particular individual stands out in my mind. I was about ready to get off my volunteer three-hour shift, and something told me to pick up the phone. It was about 10 minutes until I was about to leave, and I picked up the phone.

There was a man that wanted to commit suicide, and we talked, and we talked, and we talked. Three hours later, I finally said: Look, I'm not going to give you permission to do this. So you're going to go without my permission. I said: Secondly, I don't get paid for this. He said yeah, you do. And I said no, I don't. He says you don't care about us, you get your paycheck. And I said no, I volunteer.

And he said: Why do you do that? He said you just sat here and talked to me for nothing, for free? I said: I didn't talk to you for nothing. I said I talked to you because I care about you. He said: But you don't know me. I said: You're a member of our community. You're important to us. He said yeah, but I don't want to be here.

I said hey, there's sometimes when none of us want to be here, but we just got to pull together. We wound up talking and laughing, and about an hour later, he said: Man, thanks. I said hey, if you ever want to be a volunteer, this is how you do it. And he said you know, I might do that.

CONAN: That's a great story, Don. Did it work out? Did he come in and volunteer? Do you know?

DON: I don't know. I don't know.

CONAN: I'd like to think so, though.

DON: I like to think so. I like to think that at least that night he had somebody that really gave a damn about him. And that was all it took for him to say OK, I'm going to make it through another night.

CONAN: Thanks very much for the call, Don, appreciate it.

DON: Thank you very much.

CONAN: And Randy Raybon, as we listen to that story, one thing spoke to me, came out of it, the volunteer. Are most of the people who are manning the lines volunteers?

RAYBON: At my site, no, they're all paid staff. I definitely worked at other call centers where there are volunteers and paid staff. In general, though, you probably have more volunteers out there than paid staff.

CONAN: And what kind of training do they get?

RAYBON: For our staff there's two-day training through the Suicide Prevention Lifeline, as well as a 40-hour online workshop that we can do. And there's, you know, ongoing supervision, as well.

CONAN: And I wonder, is there - we've heard about some of the dos, are there some don'ts? Are there things you're told never to say?

RAYBON: Well, you don't want to be judgmental. You don't want to belittle the caller's problems. Going back to my cousin David, I vehemently disagree with his decision to kill himself, but that was his - that was his decision, and if I had said well, that's silly, you want to kill yourself because you can't join the right country club, that would have been amiss. You want to take the caller's concerns very seriously.

CONAN: And as you're trying to do that, how do you know when to end the call?

RAYBON: If I can get people to laugh, that's usually a good ending point. The other good ending point is if you have a good solid plan about what the next step is to keep them safe, get them through the night, get them linked to services beyond that call.

And sometimes I just say: Is this a good time to end?

CONAN: We're talking with people on the front line of suicide prevention: counselors, volunteers, military officers, law enforcement specialists. We'll talk with an officer from San Francisco in a moment. If you do this work, too, call and tell us your story, 800-989-8255. What works? Email us, talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan in Columbus, Ohio, at the studios of member station WOSU. More than 2,000 people call the National Suicide Prevention Lifeline every day by that organization's count. Roughly one in five route themselves to the Veterans Crisis Line, that hotline staffed 24 hours a day. We've posted a link to their phone number at our website. Just go to npr.org.

We've talked before on this program about the crisis of suicide. Today we're talking with some of those on the front lines of suicide prevention. If that's you, call and tell us your story. What works? 800-989-8255. Email talk@npr.org. You can also join the conversation on our website. Again that's npr.org. Click on TALK OF THE NATION.

Our guest is Randall Raybon, clinical supervisor at the Access Helpline with the D.C. Department of Mental Health. Some people in crisis pick up a phone and reach out to a help line like Randy's. Others don't. sometimes interventions happen when a passerby sees someone on a bridge or on a ledge and calls the police.

Officer Kevin Martin is with the San Francisco Police Department's Hostage Crisis Negotiation Team. He answers those calls and joins us now from member station KQED. Nice to have you on TALK OF THE NATION today.

KEVIN MARTIN: Good afternoon, thank you for having me.

CONAN: And when we think of San Francisco and suicide, we can't help but think of the Golden Gate Bridge, which has unfortunately been the site of too many. What's the first thing you do when you get a call about a possible jumper?

MARTIN: Well, there's a lot of things that cross your mind, first where the call is, how to get there, you know, safely and expeditiously. And while you're en route, you're, you know, going through a mental checklist of things that you would want to consider saying and trying to get information.

Trying to get information is very, very important so you have a base or a ground to work from. Sometimes that can be very difficult. Other times in the course of, you know, casual conversation, you ask an individual, you know, what is it that happened today to bring you here right now.

CONAN: And unlike a phone hotline, where at least the person in crisis is reaching out to somebody, it's the other way around when you're called in, right?

MARTIN: Yeah, most of our contacts are face-to-face. And that can be a double-edged sword. One is that you always want to, you know, proffer the human contact. You want to make that, you know, very evident through the thoughtful words you use and your actions.

But you're also wearing a uniform, and sometimes that can be a little daunting for a person in crisis, that the person who's coming to help is a police officer, and, you know, quite often people equate police officers, you know, in situations like this with arrest or going to jail.

And we do have to spend some time, you know, going through conversations explaining to somebody you haven't done anything wrong. You haven't broken any laws. We're just here to help you and to get you the resources and the services you need to make what you're going through easier to deal with.

CONAN: And what tends to work? People on the ledge, they're clearly right there.

MARTIN: Yeah, it's pretty intense. I've been doing this for the better part of 12 years now, and I've responded to about 25 jumpers, at least. And it depends on what the situation is, who the person is. If they're on drugs or under the influence of drugs or alcohol, that can make the situation more difficult to try to reach somebody in terms of a sensible manner.

Other times, people are on speed, methamphetamine, and that is a very, very difficult encounter because you have to keep bringing the person back onto point, and they quite often go on tangents, and that makes it, you know, difficult to center the conversation to a point of what can we do to help you, and please consider coming back a little bit closer.

CONAN: Coming back a little closer, do you sometimes try to grab them and bring them back in physically?

MARTIN: Boy, that's a real, real tough situation. We try not to do that because we do not want to put ourselves in harm's way. And other times, rash actions or quick movements can startle people, and you can end up in a tragic accident. But certainly there are times where if the situation allows, and you can divert someone's attention, you know, you might consider extracting somebody from a certain position or a certain situation that they're in.

CONAN: And I wonder, is it considered ethical to tell people lies, anything from oh, it's going to be all right to your mother's coming to see you?

MARTIN: Well, credibility is something that's incredibly important, and you have to establish that, you know, in the very beginning. Being honest, you don't lie because later on if they come through this, and they find out that you lie, next time they're in a crisis situation, if someone, you know, comes to help them out, they already have - they're behind the eight ball because they've already had a bad experience.

And the first thing, you know, they might say to a responding individual is I don't trust you, you people lied to me last time, you know, just go away, I don't want to talk to you. And of course that makes a difficult situation even more severe.

CONAN: And let me ask you the same question I asked Randy Raybon before, and that is: Do you tend to remember the successes, or do you tend to remember those who got away?

MARTIN: It's interesting, I was very intrigued by your other guest's response. And I tend to remember the ones that I have not been able to bring back to safety. And I think part of that is Monday morning quarterbacking. You question, you know, what could I have done better, what could I have said. You always relish the successes.

But you're - I tend to be a little bit more mindful of those that I was not able to bring back over to the other side.

CONAN: Are there procedures to give officers who are in your situation counseling in those situations?

MARTIN: We go through a lot of training. We initially go through a 40-hour course, instructed by the FBI. We also have a lot of in-service training, and we talk amongst each other a lot. There's a lot of seminars. But in terms of protocol and procedure, what you want to do is respond, respond safely, assess the situation and try to develop some information, try to find out something about the individual's background, if they have a criminal past, who their associates are, if they have a family.

Sometimes that can work in the negative. If someone's, you know, very upset because of a family situation, and you start talking about members of their family, that can, you know, make a situation even more difficult to go through. So asking questions and trying to develop information early on is very important.

CONAN: Randy Raybon, I wonder if you have a question for Officer Martin.

RAYBON: Well, a comment. I think the - about being honest with callers and finding things out about them - pardon me - finding things about them, you have to have just a general compassion for human beings in general, and you have to find that connection with the person that you're dealing with either in person or on the phone that makes them real and lovable.

CONAN: All right, let's get another caller in on the conversation. This is Therese(ph), Therese, how is it pronounced there in Lansing?

THERESE: It's Therese.

CONAN: Go ahead, please.

THERESE: I just wanted to say that I was a volunteer on a call-in program in - I'm sorry, I'm a little flustered. Anyway, a man called in one night and said that he couldn't give me his name, that he was a prominent man in the community and was very troubled and talked to me for quite a while.

CONAN: I'm sorry, we seem to have lost the line. I think I've made a mistake. I apologize, Therese. Call back in if you can. Let's see if we can go instead to this is Geneva(ph), Geneva with us from Louisville.

GENEVA: Hi, this is Geneva.

CONAN: Hi, go ahead please.

GENEVA: Yes, I am the clinical supervisor of the Hope Now Hotline in Louisville. We're also a part of the National Lifeline Network. And what I wanted to say was that how very much we appreciate shows like this that will put this topic out there, because one thing we found with suicide prevention that's critically important is just an awareness that resources exist that people can turn to for help, and people often don't realize that these hotlines are there.

And one thing we like to do in our community is encourage people to make that phone call to us before they get to the point where they're thinking that they want to die, that hotlines can help you out when things are just beginning to feel bad and to feel out of hand. And we really encourage that awareness that people know that we're out there and that we can help.

CONAN: Randy Raybon, that's an important point. Ultimately, you don't - you want to go out of business, but ultimately you want to get those people calling other people earlier in the process.

RAYBON: Indeed. Indeed you do. Pardon me. I was distracted by a phone. You do want to get people early on in the process. I would prefer not to have people on the edge when they're calling. It's fine if they are. Call anytime. But let's try to cut things off at the pass and solve problems early rather than later.

CONAN: And, Officer Martin, one of the things I'm sure you do is, when you do bring somebody back in, refer them to get some help that'll keep them from going out on the ledge right on to the bridge.

MARTIN: Yes. Certainly that is the goal, to bring them back and to try to make them whole. What we usually do is once we're able to make contact and convince somebody to come back, to come over to the other side, so to speak, is to take them to a mental health facility where they're able to talk to health care, you know, mental health care professionals.

What we do is we put them on what we call a 5150 Welfare and Institution hold, which is usually a 72-hour psych evaluation for people who are a danger to themselves or a danger to others. Quite often they're not there for the full 72 hours, but it's at least a start for people to get back on their meds, to try to talk to somebody in a state of clarity, to find out, you know, what is, you know, the problem, what is bothering this individual, what's pushing them to the point of taking their life.

CONAN: Hmm. Geneva, thanks very much for the call.

GENEVA: Thank you.

CONAN: We're talking with Officer Kevin Martin of the San Francisco Police Department's Hostage/Crisis Negotiation Team. Also with us is Randy Raybon, the clinical supervisor of the Access Helpline with the D.C. Department of Mental Health. We're talking with those on the frontlines of suicide prevention. You're listening to TALK OF THE NATION coming to you from NPR News.

And let's go next to - this is Joe(ph). Joe is with us from Sacramento. You're on the air. Go ahead, Joe.

JOE: Hi. Yes. I wanted to talk about - I had an officemate of five years who took his life after we worked together doing suicide prevention. And we worked in a hospital setting, and so we had a whole group of psychiatrists and psychologists and therapists who really, you know, weren't able to anticipate that in him. He saw - you know, he knew what to keep to himself and so on and so forth.

And so, you know, I just wanted to get out the message that people who are around somebody who commits suicide, that even the most highly trained people can, you know, not see it coming necessarily and that, you know, feeling, you know, guilt feelings about that, while natural, you know, sometimes you just can't prevent it. And the other thing I want to add is that in the United States, 80 percent of all suicides are committed by men.

CONAN: Hmm. I wonder, Randy Raybon, I had not heard that statistic about how heavily male suicides are. But, yes, even those who man the hotlines themselves are not immune.

RAYBON: Indeed, indeed. I've had certainly colleagues that have had mental health issues and had to leave work. And I've had colleagues that have called me personally in the middle of the night, intoxicated and suicidal. It can be a rough business. You do need to make sure that you're seeking proper peer support if it becomes overwhelming. You need to be aware of compassion fatigue and take a break, do something else.

CONAN: Officer Martin, you talked about Monday morning quarterbacking. Sometimes that can turn to guilt too.

MARTIN: That's a great point that, you know, the caller just brought up. You know, in 2010, the San Francisco Police Department suffered the loss of three officers who committed suicide and/or I think at least one or two others that had attempted suicide. And that's a whole different dynamic unto itself because of all the problems involved, especially someone in crisis who has access to weapons. That really raises the stakes, you know, considerably higher.

But in terms of Monday morning quarterbacking, I think that's a natural reaction. I think that's something that you do to just check yourself and to not to critique yourself or to make yourself feel bad, but just to question if there was something that could have been done differently or - and then sometimes you have absolutely no control.

The fact of the matter is if a person is going to commit suicide, they're going to do it, and quite often they're not going to seek help through a talk line or a counseling service or through, you know, first responders. But those who do call that are considering suicide, although they may be considering it, there's hope and there's a feeling that they don't necessarily want to, and they're reaching out to make contact for reassurances that what they're going through is difficult but it's not so extreme that it can't be worked through.

And sometimes people just need other perspectives and from people that they don't necessarily know. And that's why they - the hotlines for suicide prevention are so important throughout the country because sometimes it's easy to talk to somebody that you don't know as opposed to somebody who does, who knows your history, and it can make a situation a little bit more difficult.

CONAN: I wonder the other thing that Randy Raybon said, Officer Martin, don't be judgmental. I assume you try not to be judgmental too.

MARTIN: Absolutely not. Absolutely not.

CONAN: Joe, thanks very much for the phone call. Joe was on the line with us from Sacramento. Officer Kevin Martin joins us from KQAD, our member station in San Francisco. He's with the San Francisco Police Department's hostage crisis negotiation team. And our thanks as well to Randy Raybon, the clinical supervisor of the Access Helpline with the D.C. Department of Mental Health. Coming up - let's see. Coming up - there we go - Debora Spar, the president of Barnard College, argued that, in a recent piece, that women face a double whammy of impossible expectations and should stop trying to be perfect. She'll join us. Stay with us. I'm Neal Conan, TALK OF THE NATION, NPR News. Transcript provided by NPR, Copyright National Public Radio.